The U.S. Department of Health & Human Services introduced a groundbreaking Special Enrollment Period (SEP) in September 2021, applicable to states using HealthCare.gov (optional for others). This SEP allows year-round enrollment in ACA-compliant health insurance for individuals with a household income not exceeding 150% of the federal poverty level (FPL) and eligibility for a premium tax credit covering the benchmark plan. Initially set to run through 2025, the government is proposing a rule change to make it a permanent offering.
This SEP, effective since March 21, 2022, enables eligible applicants to enroll in ACA plans at any time, with coverage starting the following month. The SEP has no limitations on frequency or plan type, providing flexibility for low-income consumers to secure coverage. However, it is emphasized that those with income up to 150% of the poverty level are encouraged to select a Silver plan, given its built-in cost-sharing reductions that surpass even Platinum plans.
The eligibility criteria require household income not exceeding 150% of the FPL, and applicants must be eligible for premium tax credits. The SEP's permanence beyond 2025 is contingent on the continuation of premium-free benchmark plans under the American Rescue Plan's subsidy enhancements. Applicants need to attest to their income eligibility for the SEP, and state-run exchanges have the flexibility to implement the SEP based on their unique circumstances. This SEP addresses the specific needs of low-income individuals, aligning with President Biden's executive order to fortify Medicaid and the ACA.
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